Wound Care Professionals Research Articles

Medicare Resources That You Should Use.

Wound care scientists, manufacturers, and wound care professionals should take time to visit the Centers for Medicare & Medicaid Services' website. It is easy to navigate and contains information for all wound care stakeholders. This article reviews some of the most popular Medicare website pages that should prove useful to wound care stakeholders. The links to those pages are also provided.

Conservative Sharp Wound Debridement

The purpose of this study was to describe the education, policy, practice, and risk management strategies of nurses performing conservative sharp wound debridement (CSWD) in Canada, prior to the release of the Canadian Association for Enterostomal Therapy Evidence-Based Recommendations for Conservative Sharp Wound Debridement. Data collection was based on a nonrandomized, nonexperimental study design and reported using descriptive statistics. Invitations for health care professionals to participate in a CSWD scan were sent to 4315 people via e-mail through the membership lists of 2 Canadian voluntary professional wound care associations. Skip logic screened out respondents who had no experience in CSWD (n = 57). The total number of professionals who participated was 487. A 26-question electronic scan addressed demographics, education, policy, practice, and risk/quality issues related to CSWD. A comment section was included for some questions. A selected subsample of 397 nurses was chosen from the original total of 487 respondents. Nonnurse respondents were excluded due to the low total number of participants in each of these other professional categories. Nurses perform CSWD in all types of care settings in Canada from outpost nursing stations to hospital wards, homes, and long-term care facilities. The wound education preparation reported varied. The most frequently reported formal wound care education was a 2-day course (59%; n = 220), followed by an enterostomal therapy course (42%; n = 155) and the International Interdisciplinary Wound Care Course (26%; n = 98), with overlapping preparation evident. Eleven percent of respondents (n = 47) reported having taken no formal wound course, and 7% (n = 27) taught themselves to perform CSWD. Twenty-eight percent of nurses (n = 112) were unclear about whether CSWD was within their scope of practice or replied that it was not, and 69% (n = 273) did not know if there was provincial legislation that restricted their practice of CSWD. Forty-eight percent of nurses (n = 181) reported that their institutions do not have policies on CSWD, and 9% (n = 35) did not know. Adverse events associated with CSWD were reported by 196 respondents, with minor bleeding reported most frequently (98% n = 192) by those who answered the question. The education, policy, practice, and risk management of nurses practicing CSWD could benefit from development and dissemination of a set of National Standards and Competencies for this high-risk wound intervention.

Fundamentals of randomized clinical trials in wound care: Reporting standards

In wound care research, available high-level evidence according to the evidence pyramid is rare, and is threatened by a poor study design and reporting. Without comprehensive and transparent reporting, readers will not be able to assess the strengths and limitations of the research performed. Randomized clinical trials (RCTs) are universally acknowledged as the study design of choice for comparing treatment effects. To give high-level evidence the appreciation it deserves in wound care, we propose a step-by-step reporting standard for comprehensive and transparent reporting of RCTs in wound care. Critical reporting issues (e.g., wound care terminology, blinding, predefined outcome measures, and a priori sample size calculation) and wound-specific barriers (e.g., large diversity of etiologies and comorbidities of patients with wounds) that may prevent uniform implementation of reporting standards in wound care research are addressed in this article. The proposed reporting standards can be used as guidance for authors who write their RCT, as well as for peer reviewers of journals. Endorsement and application of these reporting standards may help achieve a higher standard of evidence and allow meta-analysis of reported wound care data. The ultimate goal is to help wound care professionals make better decisions for their patients in clinical practice.

Proposal for assessment of the antimicrobial efficacy of undiluted medical honey: Using a standardized phase 2/step 2 in vitro stainless steel disc carrier test model

PurposeThe antimicrobial efficacy of medical honeys used for professional wound care was published previously. So far, all in vitro antimicrobial tests performed have been conducted using non-standardized methods and used diluted medical honey. A standardized, reproducible phase 2/step 2 in vitro disc carrier model is proposed allowing testing the antimicrobial efficacy of undiluted medical honey. MethodsUsing a standardized disc carrier model, the log10 Reduction Factor (RF) of undiluted medical honey was determined for MSSA, MRSA, VRE, Pseudomonas aeruginosa, and Candida albicans, with and without protein challenge. ResultsAn antimicrobial efficacy was observed after 1h. Without organic challenge, log10RF >5 within 24h was achieved for all tested microorganisms, except for Staphylococcus aureus (log10RF: 4.8/24h). Challenged with 10% bovine serum albumin, a similar pattern was observed at 24h. The most susceptible organism was C. albicans (log10RF of >3/5min). Over an exposure time of 48h, the tested medical honey's antimicrobial activity under protein challenge achieved log10RFs >6 for C. albicans and >7log10 for all tested bacteria. ConclusionsIt was demonstrated that the proposed standardized phase 2/step 2 in vitro stainless steel disc carrier test model is applicable for testing the antimicrobial activity of highly viscous and undiluted compounds such as medical honey. Undiluted medical honey exhibits a strong antimicrobial efficacy even under protein challenge after 1h, which increases to >6log10 for C. albicans, and >7log10 for Gr+ and Gr− bacteria.

Medical honey in professional wound care

Many physicians and wound care professionals still think honey is a ‘folk remedy’ with no scientific evidence for its use in modern wound care. They believe that after the development of antibiotics and professional treatment strategies, the use of honey to treat wounds is obsolete. Researchers have shown that honey derived from Leptospermum scoparium, so called manuka honey, displays significant antibacterial effects on all clinically relevant bacterial species and also works well in combination with antibiotics. Of particular interest has been manuka honey’s intriguing activity against methicillin-resistant Staphylococcus aureus. Hospitals all over Germany, New Zealand, Australia and Austria are convinced of its benefits and use it regularly. Medical-grade honey and ready-to-use honey dressings are widely available in the EU since 2004. This manuscript intends to deal with the benefits of medical honey in professional wound care.

Professor Keith Harding, Editor‐in‐Chief of the International Wound Journal, honoured for his services to healthcare

To those outside of wound care he is a son, husband, father, grandfather, friend or neighbour. To most of us involved in wound care, Keith Harding needs no introduction and his achievements are legendary. However, whether you personally know or know of Keith, you are certainly aware of his passion and commitment to wound care and its ultimate evolution into a true clinical specialty. Indeed he has devoted the majority of his professional career to this goal and coined the phrase ‘woundologist’ of which he is a prime example. In recognition of his effort and passion, Her Majesty the Queen has conferred Professor Harding with a CBE (Commander of the Order of the British Empire) in the New Year's Honours List 2013, for his services to healthcare. This is recognition of an outstanding career, promoting the clinical specialty of wound care, benefiting those who suffer from both acute and chronic wounds not only in Wales but from other regions of the UK. Professor Harding will be invited to the Buckingham Palace in the next 6 months to receive his CBE from a member of the Royal Family at an investiture ceremony. The following is an abbreviated recap of the career of a professional wound care giver: Professor Keith Harding CBE MB ChB MRCGP FRCP FRCS has had a longstanding interest in wound healing. He has undergone training in both general surgery and general practice. He was appointed as the first Director of the Wound Healing Research Unit in 1991. From 2002 to 2005 he was also the Head of the University Department of Surgery and is currently the Director of the TIME Institute, School of Medicine, Cardiff University; Head of the Wound Healing Research Unit, Cardiff University; and Clinical Director of Wound Healing in the Cardiff & Vale NHS Trust. His clinical practice is exclusively focused on treating patients with wound healing problems having a wide range of aetiologies. He has authored over 300 publications in the field of wound healing and has written a number of chapters and books in this area, including the ABC of Wound Healing published in the British Medical Journal in 2006 which is to be updated in 2013. He is the Editor-in-Chief of the International Wound Journal published by Wiley-Blackwell. He was the First President of the European Pressure Ulcer Advisory Panel, First Recorder of the European Wound Management Association and is a Past President of the European Tissue Repair Society. He was Chair of the International Working Group on Wound Healing in Diabetic Foot Disease in 2003, Chair of the Expert Working Group that produced the World Union of Wound Healing Societies (WUWHS) Consensus Document in 2004 on minimising pain during wound dressing related procedures. He was Chair of the WUWHS Expert Working Groups on Exudate in 2007 and on Compression, VAC therapy and Wound Diagnostics in 2008. He was also Chair of International Consensus Document on wound infection in 2008. He chaired an International Working Group on Pressure Ulcer Prevention, Prevalence and Evidence in Context, which was published in 2009. He has obtained funding of over £30 million from a range of academic, commercial and clinical sources since the Wound Healing Research Unit was created in 1991. Much has been achieved over the past three decades but being awarded this high honour is recognition of true dedication and lifetime achievement in a field close to the hearts of our readership. Please join me in congratulating Keith on this fine achievement, which I know he will say he is accepting on behalf of his team, as nothing is really achieved without a true professional multi-disciplinary approach.

The Broad Street Pump

FigureI recall the great anticipation of my first class in medical epidemiology where we learned the principles of incidence, prevalence, point prevalence, transmission of disease, vectors, hosts, fomites, and so on. The class seemed daunting and unimaginably boring. Despite this initial impression, the instructor had an unmistakable aura about him that was accentuated by his gold-rimmed, rounded spectacles. He was a sage US Army Colonel and physician who specialized in “tropical medicine.” You could easily imagine him wearing a British khaki uniform, complete with Bermuda shorts and a pith helmet, tromping around in faraway places. Unexpectedly, the instructor began the session with a story about the “Broad Street pump.” This single story ignited and held my interest in the concepts of medical investigation, the basics of epidemiology, and preventive medicine, even to this day. In 1854, the English physician (the father of epidemiology) John Snow discovered the link to the lethal cholera epidemic, which killed tens of thousands of people in England between 1831 and 1854. Although the etiology of cholera was unknown, the strong belief at the time was that it was caused by breathing vapors, a “miasma,” or foul air. In 1854, the London suburb of Soho was the epicenter of an endemic cholera outbreak that led to 500 deaths in 10 days.1–3 Snow used what are now known as epidemiologic principles to investigate the causation through interviewing people (cases) who were stricken with cholera and those who were not. He compared the incidence and prevalence of those who lived in the “surveillance” area with and without the disease. Snow discovered that the commonality between those with the disease was where they drew their drinking water—the Broad Street Well. One major source of evidentiary contamination was a case of a mother washing diapers and dumping the waste into a leaky cesspool, just 3 feet from the Broad Street pump, which was probably the tip of the iceberg. Through meticulous recordkeeping and epidemiologic interviewing techniques, Snow was able to triangulate commonalities and establish causation. He observed that all of its victims drew their drinking water from the same well. Snow removed the pump handle, and the epidemic ended. The infamous Broad Street pump is now a memorial to the triumph of medical epidemiology. Although cholera was endemic to London in the 19th century, its original reservoir was in the Ganges Delta in India. And during the 20th century, 6 subsequent pandemics killed millions of people across all continents. The current (seventh) pandemic started in South Asia in 1961 and reached Africa in 1971 and the Americas in 1991. Cholera is now endemic in many countries. We now know that cholera is spread by contaminated water and not from person to person. And finally, we now have vaccines for cholera.1–3 This month’s continuing medical education activity on page 35 is a primer on medical intelligence in wound care. Wound care professionals who operate at the point of service need to develop core competencies in gathering intelligence data about incidence and prevalence of pressure ulcers. In this case, the intelligence is in the form of gathering epidemiological information to be used by the institution providing and improving care, to feed the data to interested parties in general, and, in particular, to payers, hospital credentialing, and accreditation organizations. In addition, the use of prevalence and incidence data can be used to implement the plan-do-study-act cycle for quality improvement and clinical management, patient care, and educational continuous quality improvement plans, especially as we move into an area of accountable care and pay for performance.4 Recently at the 27th Anniversary Clinical Symposium several of the poster winners included epidemiologic studies demonstrating the importance of using statistical measures in wound care and reducing the incidence of new pressure ulcers in a given hospital organization. One case used a multinational study to illustrate the applicability of the use of data to institute prevention programs and improve patient outcomes. Medical surveillance in wound management is a strategy that is as important as any.FigureRichard “Sal” Salcido, MD

Addressing the Educational Needs of Wound Care Professionals

Addressing the Educational Needs of Wound Care Professionals

Rapid Healing of Scar-Associated Chronic Wounds After Ablative Fractional Resurfacing

Skin compromised by traumatic scars and contractures can manifest decreased resistance to shearing and other forces, while increased tension and skin fragility contribute to chronic erosions and ulcerations. Chronic wounds possess inflammatory mediator profiles and other characteristics, such as the presence of biofilms, that can inhibit healing. Three patients with multiple traumatic scars related to blast injuries initiated a course of ablative fractional laser therapy for potential mitigation of contractures, poor pliability, and textural irregularity. Patients also had chronic focal erosions or ulcerations despite professional wound care. All patients experienced incidental rapid healing of their chronic wounds within 2 weeks of their initial ablative fractional laser treatment. Healing was sustained throughout the treatment course and beyond and was associated with gradual enhancements in scar pliability, texture, durability, and range of motion. The unique pattern of injury associated with ablative fractional laser treatment may have various potential wound-healing advantages. These advantages include the novel concept of photomicrodebridement, including biofilm disruption and the stimulation of de novo growth factor secretion and collagen remodeling. If confirmed, ablative fractional resurfacing could be a potent new addition to traditional wound and scar treatment paradigms.

Wound care with traditional, complementary and alternative medicine

Wound care is constantly evolving with the advances in medicine. Search for the ideal dressing material still continues as wound care professionals are faced with several challenges. Due to the emergence of multi-resistant organisms and a decrease in newer antibiotics, wound care professionals have revisited the ancient healing methods by using traditional and alternative medicine in wound management. People's perception towards traditional medicine has also changed and is very encouraging. The concept of moist wound healing has been well accepted and traditional medicine has also incorporated this method to fasten the healing process. Several studies using herbal and traditional medicine from different continents have been documented in wound care management. Honey has been used extensively in wound care practice with excellent results. Recent scientific evidences and clinical trials conducted using traditional and alternative medicine in wound therapy holds good promise in the future.

Multicentre prospective observational study on professional wound care using honey (Medihoney™)

In recent years, the treatment of wounds with honey has received an increasing amount of attention from healthcare professionals in Germany and Austria. We conducted a prospective observational multicentre study using Medihoney™ dressings in 10 hospitals - nine in Germany and one in Austria. Wound-associated parameters were monitored systematically at least three times in all patients. Data derived from the treatment of 121 wounds of various aetiologies over a period of 2 years were analysed. Almost half of the patients were younger than 18 years old, and 32% of the study population was oncology patients. Overall, wound size decreased significantly during the study period and many wounds healed after relatively short time periods. Similarly, perceived pain levels decreased significantly, and the wounds showed noticeably less slough/necrosis. In general, our findings show honey to be an effective and feasible treatment option for professional wound care. In addition, our study showed a relationship between pain and slough/necrosis at the time of recruitment and during wound healing. Future comparative trials are still needed to evaluate the extent to which the positive observations made in this and other studies can definitely be attributed to the effects of honey in wound care.

Honoring the Past and Forging the Future

Honoring the Past and Forging the Future

Addressing the Educational Needs of Wound Care Professionals

Advances in Skin & Wound Care: January 2012 - Volume 25 - Issue 1 - p 10 doi: 10.1097/01.ASW.0000410681.14432.2d

Content Validation of Terms and Definitions in a Wound Glossary

ObjectiveA common language and lexicon provide the easiest means of mutual understanding. Inconsistency in terminology makes effective information exchange difficult. Previous studies identified the need to determine standard, accepted definitions for the vocabulary frequently used in wound care. The objective of this study was to establish content validation for these terms and develop an evidence-based glossary for this specialty. MethodsMembers of the Association for the Advancement of Wound Care Quality of Care Task Force reviewed literature to determine glossary content generation and the associated literature-based definitions. Thirty-nine wound care professionals from wound care stakeholder professional organizations in the United States and Canada participated in the content validation process. Participants were asked to quantify the degree of validity using a 367-item, 4-point Likert-type scale. ResultsOn a scale of 1 to 4, the mean score of the entire instrument was 3.84. The instrument’s overall scale content validity index was 0.96. Terms with an item content validity index of less than 0.70 were removed from the glossary, leaving 365 items with established content validity. Qualitative data analysis revealed themes suggesting that enhanced communication between providers improves patient outcomes. The need for ongoing updates of the glossary was also identified. ConclusionThe wound care glossary in its finalized form proved valid. An evidence-based glossary bridges the chasm of miscommunication and nonstandardization so that wound care, as an emerging specialized medical science field, can move forward to optimize both process and clinical outcomes.

Consider the OIG Work Plan in Your 2012 Internal Audit Schedules

Wound care professionals should conduct monthly internal audits of their business processes. In addition to auditing, the coding, payment, and coverage issues that are considered issues by the Medicare contractor that processes your claims and the Medicare contractors that audit your claims and payments, be sure to include the OIG Work Plan topics that pertain to your wound care business. Remember, if atopic is important enough to make the OIG Work Plan, it should be important enough to make your 2012 internal audit plan. Because the Medicare Trust Fund is important to all US citizens, everyone has a responsibility to assist in combating fraud, waste, abuse, and mismanagement in HHS programs. Therefore, the OIG Hotline accepts tips from all sources. To provide a tip to the OIG Hotline, see Table 1 for contact information.

Addressing the Educational Needs of Wound Care Professionals

Addressing the Educational Needs of Wound Care Professionals

Etiology of chronic leg ulcers in 31,619 patients in Germany analyzed by an expert survey

The etiology of chronic leg ulcers is heterogenous and they exhibit quite different healing rates depending on the underlying cause. Although the prevalence and incidence of chronic leg ulcers appear to be increasing, data on these patients in Germany are lacking. Altogether 100 German wound care professionals were asked to complete a questionnaire regarding the diagnosis and etiology of their patients with chronic leg ulcers. We received the data on 31,619 patients. In these patients, venous insufficiency was the dominating causative factor in 47.6 % and arterial insufficiency in 14.5 %, 17.6 % of ulcers were due to combined arterial and venous insufficiency. Rarer causes included vasculitis (5.1 %), exogenous factors (3.8 %), pyoderma gangrenosum (3.0 %), infection (1.4 %), neoplasia (1.1 %), calciphylaxis (1.1 %) and drug-induced (1.1 %). The used diagnostic methods used varied widely between the medical and surgical specialties. Even though the results of our study cannot claim to be a representative overview, they demonstrate clearly that next to known etiologies, e. g. chronic venous insufficiency or peripheral arterial insufficiency, which are relevant in 79.7 % of all patients a multitude of other causes exist, which are responsible in 20.3 % of all patients for the development of chronic leg ulcers.

Development and Implementation of a Professional Wound Care Training Program for Nurses in Taiwan

Development and Implementation of a Professional Wound Care Training Program for Nurses in Taiwan

Comparative analysis of two methods for wound bed area measurement

Wound bed area measurements are considered to be an essential part of the wound assessment process. Wound care professionals should be aware of the reliability and validity of the techniques they use. The purpose of this study was to assess whether wound care professionals are able to make as accurate and reproducible a measurement of the wound bed area using two methods for area measurement. Five wound care professionals independently assessed 2285 digital wound images for the wound bed area. Each image was measured in random order, three times, and in four angles by providing the rotated versions of each image (0°, 90°, 180° and 270°). Two techniques were compared: free hand drawing and closed polygon (CP) graph algorithm. Comparison of the two techniques showed differences that are, in our opinion, not acceptable in clinical practice when these techniques are used interchangeably and/or the measurements are carried out by different observers. Variations observed between wounds and observers seem related to the difference in perception of the wound bed margin. Our results indicate that repetition of CP graph area measurement results in the lowest difference in repetitive measurements. Study limitations are related to an incomplete consensus on definitions of wound, wound bed, wound edge and wound border. The development of an ontology related to wound images could aid to reduce these ambiguities.

SELECT: Evaluation and Implementation of Clinical Practice Guidelines

American Professional Wound Care Association and Those involved in the preparation of this document are as follows: Core Committee: Steven R. Kravitz, DPM, FAPWCA, Co-chairperson; Diane Krasner, RN, PhD, FAPWCA, Co-chairperson; Elizabeth A. Ayello, RN, PhD, FAPWCA; James McGuire, DPM, FAPWCA; R. Gary Sibbald, MD, FAPWCA; Adrianne P. Smith, MD, FAPWCA; Pamela Unger, PT, DAPWCA; Kevin Woo, RN, PhD, FAPWCA; and Gail Woodbury, PT, PhD, AAPWCA. Medical Writers: Kevin Woo, RN, PhD, FAPWCA, and Gail Woodbury, PT, PhD, AAPWCA. Panel of Reviewers: Sharon Baranoski, RN, DAPWCA; Mona Baharestani, APN, PhD, FAPWCA; David Brotman, MD, FAPWCA; Nancy Collins, RD, PhD, FAPWCA; Michael Edmonds, MD, FAPWCA; Robert Frykberg, DPM, FAPWCA; Lester J. Jones, DPM, FAPWCA; Dieter Mayer, MD, FAPWCA; Darlene McCord, PhD, FAPWCA; Mary Ellen Posthauer, RD, CD, LD; and Michael Trepal, DPM, FAPWCA. APWCA Board of Directors: David Brotman, MD, FAPWCA, President; Michael Fusaro, DPM, FAPWCA, Vice President; Brenda Laboda, RN, CWS, DAPWCA, Secretary; Federico Peguero, MD, FAPWCA, Treasurer; Robert Gunther, DPM, FAPWCA, Immediate Past President. Board Members at Large: Elizabeth A. Ayello, PhD, RN, FAPWCA; Sharon Baranoski, RN, DAPWCA; Thomas A. Kwyer, MD, FAPWCA; June Partyka, RN, CWOCN, DAPWCA; and Larry Schuster, DPM, FAPWCA. Executive Director: Steven R. Kravitz, DPM, FAPWCA.